Caroline’s Story

Caroline is six years old, with bright brown eyes and, at the moment, no front teeth, like so many other first graders. She also wears a hearing aid in each ear—and has done so since she was three, when she was diagnosed with a moderate hearing loss.

For Caroline’s parents, there were many clues along the way. Caroline often didn’t respond to her name if her back was turned. She didn’t startle at noises that made other people jump. She liked the TV on loud. But it was the preschool she started attending when she was three that first put the clues together and suggested to Caroline’s parents that they have her hearing checked. The most significant clue to the preschool was Caroline’s unclear speech, especially the lack of consonants like “d” and “t” at the end of words.

So Caroline’s parents took her to an audiologist, who collected a full medical history, examined the little girl’s ears inside and out, ran a battery of hearing tests and other assessments, and eventually diagnosed that Caroline’s inner ear (the cochlea) was damaged. The audiologist said she had sensorineural hearing loss.

Caroline was immediately fitted with hearing aids. She also began receiving special education and related services through the public school system. Now in the first grade, she regularly gets speech therapy and other services, and her speech has improved dramatically. So has her vocabulary and her attentiveness. She sits in the front row in class, an accommodation that helps her hear the teacher clearly. She’s back on track, soaking up new information like a sponge, and eager for more.

About Hearing Loss in Children

Hearing is one of our five senses. Hearing gives us access to sounds in the world around us—people’s voices, their words, a car horn blown in warning or as hello!

When a child has a hearing loss, it is cause for immediate attention. That’s because language and communication skills develop most rapidly in childhood, especially before the age of 3. When hearing loss goes undetected, children are delayed in developing these skills (March of Dimes, 2010).

Recognizing the importance of early detection, the Centers for Disease Control and Prevention (the CDC) recommends that every newborn be screened for hearing loss as early as possible, usually before they leave the hospital. Catching a hearing loss early means that treatment can start early as well and “help the child develop communication and language skills that will last a lifetime” (CDC, 2013).

Types of Hearing Loss

Before we describe the types of hearing loss a person may have, it’s useful to know that sound is measured by:

its loudness or intensity (measured in units called decibels, dB); and

its frequency or pitch (measured in units called hertz, Hz).

Hearing loss is generally described as slight, mild, moderate, severe, or profound, depending upon how well a person can hear the intensities or frequencies most strongly associated with speech. Impairments in hearing can occur in either or both areas, and may exist in only one ear or in both ears. Generally, only children whose hearing loss is greater than 90 decibels (dB) are considered deaf.

Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear (the pathways for sound to reach the inner ear). Conductive hearing losses usually affect all frequencies of hearing evenly and do not result in severe losses. A person with a conductive hearing loss usually is able to use a hearing aid well or can be helped medically or surgically.

Sensorineural hearing losses result from damage to the delicate sensory hair cells of the inner ear or the nerves that supply it. These hearing losses can range from mild to profound. They often affect the person’s ability to hear certain frequencies more than others. Thus, even with amplification to increase the sound level, a person with a sensorineural hearing loss may perceive distorted sounds, sometimes making the successful use of a hearing aid impossible.

A mixed hearing loss refers to a combination of conductive and sensorineural loss and means that a problem occurs in both the outer or middle and the inner ear.

A central hearing loss results from damage or impairment to the nerves or nuclei of the central nervous system, either in the pathways to the brain or in the brain itself.

complications during pregnancy (such as the Rh factor, maternal diabetes, or toxicity).

A child’s hearing loss or deafness may also be a characteristic of another disability such as Down syndrome, Usher syndrome, Treacher Collins syndrome, Crouzon syndrome, and Alport syndrome (American Speech-Language-Hearing Association, n.d.).

In all cases, early detection and treatment are very important to the child’s development.

Is There Help Available?

Yes, there’s a lot of help available, beginning with the free evaluation of the child. The nation’s special education law, the Individuals with Disabilities Education Act (IDEA), requires that all children suspected of having a disability be evaluated without cost to their parents to determine if they do have a disability and, because of the disability, need special services under IDEA. Those special services are:

Early intervention | A system of services to support infants and toddlers with disabilities (before their 3rd birthday) and their families.

To access special education and related services: We recommend that you get in touch with your local public school system. Calling the elementary school in your neighborhood is an excellent place to start. The school should be able to tell you the next steps to having your child evaluated free of charge and, if found eligible, he or she can begin receiving services specially designed to address your child’s needs.

There are also special services available to low-income children through the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program, the child health component of Medicaid. To learn more about the EPSDT program, visit: http://www.hrsa.gov/epsdt/

Definition in IDEA

It’s helpful to know that, while the terms “hearing impairment” and “hearing loss” are often used to describe a wide range of hearing losses, including deafness, IDEA actually defines the two terms separately, as follows:

Hearing impairment is defined by IDEA as “an impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance.”

Deafness is defined as “a hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with or without amplification.”

Thus, deafness is viewed as a condition that prevents an individual from receiving sound in all or most of its forms. In contrast, a child with a hearing loss can generally respond to auditory stimuli, including speech.

Educational Implications

Hearing loss or deafness does not affect a person’s intellectual capacity or ability to learn. However, children who are hard of hearing or deaf generally require some form of special education services in order to receive an adequate education. Such services may include:

regular speech, language, and auditory training from a specialist;

amplification systems;

services of an interpreter for those students who use sign language;

favorable seating in the class to facilitate lip reading;

captioned films/videos;

assistance of a notetaker, who takes notes for the student with a hearing loss, so that the student can fully attend to instruction;

instruction for the teacher and peers in alternate communication methods, such as sign language; and
counseling.

Children who are hard of hearing will find it much more difficult than children who have normal hearing to learn vocabulary, grammar, word order, idiomatic expressions, and other aspects of verbal communication. For children who are deaf or have severe hearing losses, early, consistent, and conscious use of visible communication modes (such as sign language, fingerspelling, and Cued Speech) and/or amplification and aural/oral training can help reduce this language delay.

By age four or five, most children who are deaf are enrolled in school on a full-day basis and do special work on communication and language development. Parents work with school personnel to develop an individualized education program (IEP) that details the child’s special needs and the services and supports that will be provided to meet those needs. IDEA requires that the IEP team address the communication needs of a child who is deaf or hard of hearing.

It is important for teachers and audiologists to work together to teach the child to use his or her residual hearing to the maximum extent possible, even if the preferred means of communication is manual. Since the great majority of deaf children (over 90%) are born to hearing parents, programs should provide instruction for parents on implications of deafness within the family.

People with hearing loss use oral or manual means of communication or a combination of the two. Oral communication includes speech, lip reading, and the use of residual hearing. Manual communication involves signs and fingerspelling. Total Communication, as a method of instruction, is a combination of the oral method plus signing and fingerspelling.

Using the Relay Service

Individuals with hearing loss, including those who are deaf, now have many helpful devices available to them. Text telephones (known as TTs, TTYs, or TDDs) enable persons to type phone messages over the telephone network.

The Telecommunications Relay Service (TRS) makes it possible for TT users to communicate with virtually anyone (and vice versa) via telephone through a communications assistant. Dial 711 to access all telecommunications relay services anywhere in the United States. The relay service is free.

Resources

In alphabetical order, here’s a starter list of organizations providing info and guidance on deafness and hearing loss. Explore the sites below and the wealth of material they offer on types of hearing loss, newborn and early childhood screening, the EHDI program for early detection of hearing loss, guidance for parents, suggestions for educators working with children who are deaf or hard of hearing, and much more.

Alexander Graham Bell Association for the Deaf and Hard of Hearing | www.agbell.org

Accessibility

The people who work on the CPIR are not just advocates by profession—everyone on our team has a personal stake in the disability community as a parent, sibling, spouse, or otherwise.

The CPIR strives to be ever conscious of accessibility in technology. In compliance with Section 508 of the Rehabilitation Act, we have endeavored to make our website as accessible as possible, less any undue burden that would be imposed on us.

Compliance is an ongoing process on an active site such as the Hub. If anyone has difficulty accessing our website information and resources, we encourage you to reach out to us directly so that we can improve our efforts to accommodate our audience.

Ideas That Work

This website was produced under U.S. Department of Education, Office of Special Education Programs No. H328R180005. The views expressed herein do not necessarily represent the positions or policies of the Department of Education. No official endorsement by the U.S. Department of Education of any product, commodity, service or enterprise mentioned on this website is intended or should be inferred. This product is public domain. Authorization to reproduce it in whole or in part is granted. While permission to reprint material from this website is not necessary, the citation should be: Center for Parent Information and Resources (retrieval date). Title of the document, Newark, NJ, Author.